| NPI | 1861438665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR C-5953) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AR C-5953) |
| 207R00000X Internal Medicine (Licence: AR C-5903) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-03-03 |